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Thanks for adding the additional information. I can sure see why you're tired with an AHI north of 20. Sometimes the clear airway events are central, and sometimes they are just sleep disturbance. Do you know how much time you spend in apnea (minutes) and what duration the OA and CA events are? Zooming in on the wave form in Sleepyhead can sometimes give you insights of what pressure you're at when those events happen and the duration.

I'm going to be starting on a BiPAP Auto 60 series tomorrow, so I'll join you in exploring what the bilevel machine can do. If I was to make any recommendations it is that you could do some minor tweaks and observe the response. You still have a pretty high OA event level. I might actually raise the EPAP by 1 cm to see if that can improve AHI without worsening CA. Experimenting is really the only path I see to trying to solve the puzzle and own the therapy. So one thing, and a little bit at a time, and let's see where it goes.

Easiest way to post Sleepyhead data is to take screen shots (F12) and load the image data to a free online image hosting site like Imgur or Photobucket. Then copy the image URL address and put it in IMG brackets here.

Thanks for adding the additional information. I can sure see why you're tired with an AHI north of 20. Sometimes the clear airway events are central, and sometimes they are just sleep disturbance. Do you know how much time you spend in apnea (minutes) and what duration the OA and CA events are? Zooming in on the wave form in Sleepyhead can sometimes give you insights of what pressure you're at when those events happen and the duration.

I'm going to be starting on a BiPAP Auto 60 series tomorrow, so I'll join you in exploring what the bilevel machine can do. If I was to make any recommendations it is that you could do some minor tweaks and observe the response. You still have a pretty high OA event level.I might actually raise the EPAP by 1 cm to see if that can improve AHI without worsening CA. Experimenting is really the only path I see to trying to solve the puzzle and own the therapy. So one thing, and a little bit at a time, and let's see where it goes.

Easiest way to post Sleepyhead data is to take screen shots (F12) and load the image data to a free online image hosting site like Imgur or Photobucket. Then copy the image URL address and put it in IMG brackets here.

Your snore index is suggestive that: "I might actually raise the EPAP by 1 cm to see if that can improve AHI without worsening CA."

I think that might be an important point. It is good to know if they are occurring naturally or not, because then you can figure out how to tackle that issue.

You are reporting that under therapy CAs are ~4-5 times other events, which seems a bit high to me (who is hardly an expert).

I assume you had a sleep study where part or all of it did not include xPAP therapy. I had an original home test, for instance, and CAs were like 1 or 2 for the entire night, but total events was like 56 per hour. But since therapy, CAs have been about twice what OAs have been. AHI itself is much, much lower, but those CAs have to be coming from somewhere. If not pressure-induced, then from where? It is something that is pretty prevalent in xPAP therapy for a lot of patients.

So, did you have an unaided (by PAP) sleep study or portion of a sleep study, and what were the CAs there?

The way to determine (with limited assurance) that they are pressure-induced is to compare what the CA index was without pressure at all (assuming you had a study like that) to what it is now, and possibly to lower the max (or even the min) pressure for a short time to see if those numbers (or numbers for other types of events) decrease (or increase) significantly. That will give you a better idea what you are dealing with.

Also, a pressure of 15/10 sounds suspiciously like a partially-educated guess, a starting point chosen by your sleep doc based on the limited info he had at the time. 15 and 10 are numbers that are just "too conveniently round". It could be SOP in his practice to start someone who presents with your symptoms and readings at 15/10, and then fine-tune after there is more data over time.

Bottom line, and especially since there is more data now, I suggest scheduling another appointment with the sleep doc to discuss all of this.

Bloody mucus? That seems a bit alarming. I have never had that, and so it does not seem normal at all, although up north when humidity goes away in the winter, I have heard of folks getting a lot of nosebleeds, which is supposed to have something to do with them producing a surplus of blood, possibly due to colder weather. But I really do not know how any of that works.

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